Introduction The American Cancer Society estimates there will be 4000 new cases of vulvar cancer for the year 2003(1). The majority of these patients will undergo surgical therapy with groin node dissection to assess the inguinal nodal chain for evidence of metastatic disease. For many years there has been a search for a less radical surgical approach to evaluating the inguinal lymphatic basin. The classic approach to vulvar cancer was an en-bloc resection of the vulva and groins with a single incision. This approach led to complication rates as high as 69% for chronic leg edema and 85 % for wound breakdown(2). In an effort to reduce the morbidity of groin node dissections, the triple incision technique was introduced(3). A GOG study evaluating limited surgery with wide local excision and superficial groin node dissection reported rates of chronic lymphedema of 19% and wound infection and or separation of 29%(4). In their report on penile carcinoma the concept of a sentinel node as the first group of nodes in the inguinal lymphatic chain was put forth by Cabanas et al.(5). Morton and colleagues advanced the technique of sentinel node lymphatic mapping in patients with cutaneous melanoma(6). In 1994 Levenback et al, described of the use of isosulfan blue dye for the detection of sentinel nodes in the inguinal lymphatic chain(7). To date, a number of studies have been performed evaluating the utility of sentinel node technology and its application in vulvar malignancies (Table 1)(7-20). For melanoma, the sentinel node dissection has become the standard of care for the evaluation of the lymphatic basins. Many cancer centers, including Women and Infants' Hospital, use sentinel node dissection for the evaluation of axillary nodes in breast cancer patients as their standard of care. This technology has decreased the rate of chronic arm edema in breast cancer patients.